Treatment of Lower Lumbar Radiculopathy Caused by Osteoporotic Compression Fracture: The Role of Vertebroplasty

Abstract

The authors used vertebroplasty for the treatment of severe lower lumbar radicular pain caused by osteoporotic compression fracture. Patients presented with severe radiating leg pain rather than lower back pain from recent osteoporotic compression fracture of lower lumbar vertebra. Radiologic findings showed osteoporotic compression fracture combined with preexisting stenosis of the intervertebral foramen resulting in root compression. After injection of polymethylmethacrylate into the compressed vertebral body through the pedicle of the symptomatic side, all seven patients experienced dramatic pain relief that lasted throughout the mean follow-up duration of 9.1 months. They conclude that vertebroplasty may be an effective way of relieving radicular pain caused by osteoporotic compression fracture combined with foraminal stenosis.

Radiculopathy Caused by Osteoporotic Vertebral Fractures in the Lumbar Spine

“…Recurrent radicular pain developed during the short-term follow-up period at mean 9.1 months after vertebroplasty for symptomatic LFS following OVF in two of seven previously reported patients. 2) The present results suggest that spinal fusion with instrumentation may provide better surgical outcomes, but application is often limited in patients with OVF because of their poor general condition and spinal fragility. In addition, new OVFs developed postoperatively in two of the three patients treated with PLIF, indicating that spinal fixation can potentially influence the incidence of new OVFs.…”

“…3,5,6,12) OVFs in the lower lumbar spine occasionally induce radiculopathy. 2) In our experience, radiculopathy develops in patients with OVF much more frequently than in patients with myelopathy or cauda equina syndrome. This radicular pain often limits the activities of daily living (ADL).…”

“…Vertebroplasty was performed in Case 9 to achieve indirect nerve root decompression through reconstruction and stabilization of the fractured vertebral body. 2) Vertebroplasty was performed in Case 8 to stabilize pseudoarthrosis of the fractured vertebrae, which was expected to provide better spinal condition following PLIF procedures (Fig. 2C, D).…”

Kyphoplasty and vertebroplasty

“…As experience grows with these techniques, various groups are pushing the envelope on indications for the procedure, with the possibility of seeing more complications in this patient group. There are some preliminary data/case series on efficacy in patients with radicular pain, traumatic burst fractures, severe VCF/vertebral plana, cervical spine pathology, and intraoperative PMMA augmentation of pedicle screw fixation spinal stabilization [20][21][22][23]. In our center, we have pushed "relative" contraindications in cancer patients without increased morbidity, even in those with very advanced cancers [24,25].…”

Reviewer?s comment on: Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures (I.N. Gaitanis et al.)

“…The combination of an OVCF with a pre-existing stenosis at the same spinal segment is a more challenging clinical scenario, in which posterior decompression would increase traumatic instability and cement augmentation might trigger radicular symptoms if some degree of intracanal cement leak occurred. However, Chung et al described seven patients in whom root compression resulted from combined OVCF and pre-existing stenosis of the intervertebral foramen [1]. After injection of polymethylmethacrylate into the compressed vertebral body through the pedicle of the symptomatic side, all seven patients experienced pain relief that lasted until last follow-up.…”